Skip to main content

Advertisement

SpringerLink
Log in

Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: evaluation of CT severity index, interobserver agreement and radiation dose

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To intra-individually compare single-portal-phase low-tube-voltage (100-kVp) computed tomography (CT) with 120-kVp images for short-term follow-up assessment of CT severity index (CTSI) of acute pancreatitis, interobserver agreement and radiation dose.

Methods

We retrospectively analysed 66 patients with acute pancreatitis who underwent initial dual-contrast-phase CT (unenhanced, arterial, portal phase) at admission and short-term (mean interval 11.4 days) follow-up dual-contrast-phase dual-energy CT. The 100-kVp and linearly blended images representing 120-kVp acquisition follow-up CT images were independently evaluated by three radiologists using a modified CTSI assessing pancreatic inflammation, necrosis and extrapancreatic complications. Scores were compared with paired t test and interobserver agreement was evaluated using intraclass correlation coefficients (ICC).

Results

Mean CTSI scores on unenhanced, portal- and dual-contrast-phase images were 4.9, 6.1 and 6.2 (120 kVp) and 5.0, 6.0 and 6.1 (100 kVp), respectively. Contrast-enhanced series showed a higher CTSI compared to unenhanced images (P < 0.05) but no significant differences between single- and dual-contrast-phase series (P > 0.7). CTSI scores were comparable for 100-kVp and 120-kVp images (P > 0.05). Interobserver agreement was substantial for all evaluated series and subcategories (ICC 0.67–0.93). DLP of single-portal-phase 100-kVp images was reduced by 41 % compared to 120-kVp images (363.8 versus 615.9 mGy cm).

Conclusions

Low-tube-voltage single-phase 100-kVp CT provides sufficient information for follow-up evaluation of acute pancreatitis and significantly reduces radiation exposure.

Key Points

• Single-portal-phase CT provides sufficient evaluation for follow-up of acute pancreatitis.

• Follow-up CT does not benefit from unenhanced or arterial-phase acquisition.

• CT severity index scores are equal for dual-contrast-phase 100-/120-kVp acquisition (P > 0.05).

• 100-kVp single-portal-phase follow-up CT of acute pancreatitis significantly reduces radiation exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174:331–336

    Article  PubMed  CAS  Google Scholar 

  2. McNulty NJ, Francis IR, Platt JF et al (2001) Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220:97–102

    Article  PubMed  CAS  Google Scholar 

  3. Morgan DE, Ragheb CM, Lockhart ME et al (2010) Acute pancreatitis: computed tomography utilization and radiation exposure are related to severity but not patient age. Clin Gastroenterol Hepatol 8:303–308

    Article  PubMed  Google Scholar 

  4. O’Connor OJ, Buckley JM, Maher MM (2011) Imaging of the complications of acute pancreatitis. Am J Roentgenol 197:W375–W381

    Article  Google Scholar 

  5. O’Connor OJ, McWilliams S, Maher MM (2011) Imaging of acute pancreatitis. Am J Roentgenol 197:W221–W225

    Article  Google Scholar 

  6. Kwon Y, Park HS, Kim YJ et al (2012) Multidetector row computed tomography of acute pancreatitis: utility of single portal phase CT scan in short-term follow up. Eur J Radiol 81:1728–1734

    Article  PubMed  Google Scholar 

  7. Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–613

    Article  PubMed  Google Scholar 

  8. Konzen KM, Perrault J, Moir C, Zinsmeister AR (1993) Long-term follow-up of young patients with chronic hereditary or idiopathic pancreatitis. Mayo Clin Proc 68:449–453

    Article  PubMed  CAS  Google Scholar 

  9. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  10. Scaglione M, Casciani E, Pinto A et al (2008) Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR 29:322–340

    Article  PubMed  Google Scholar 

  11. Macari M, Spieler B, Kim D et al (2010) Dual-source dual-energy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp. Am J Roentgenol 194:W27–W32

    Article  Google Scholar 

  12. Nakayama Y, Awai K, Funama Y et al (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951

    Article  PubMed  Google Scholar 

  13. Marin D, Nelson RC, Barnhart H et al (2010) Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique–preliminary results. Radiology 256:450–459

    Article  PubMed  Google Scholar 

  14. Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271:327–342

    Article  PubMed  Google Scholar 

  15. Heye T, Nelson RC, Ho LM et al (2012) Dual-energy CT applications in the abdomen. Am J Roentgenol 199:S64–S70

    Article  Google Scholar 

  16. Mortele KJ, Wiesner W, Intriere L et al (2004) A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am J Roentgenol 183:1261–1265

    Article  Google Scholar 

  17. Menzel H, Schibilla H, Teunen D (2000) EUR 16262 EN: European guidelines on quality criteria for computed tomography. European Commission, Luxembourg

    Google Scholar 

  18. Yadav D (2011) Recent advances in the epidemiology of alcoholic pancreatitis. Curr Gastroenterol Rep 13:157–165

    Article  PubMed  Google Scholar 

  19. Vaughn DD, Jabra AA, Fishman EK (1998) Pancreatic disease in children and young adults: evaluation with CT. Radiographics 18:1171–1187

    Article  PubMed  CAS  Google Scholar 

  20. Lowe ME, Greer JB (2008) Pancreatitis in children and adolescents. Curr Gastroenterol Rep 10:128–135

    Article  PubMed  Google Scholar 

  21. Yeh BM, Shepherd JA, Wang ZJ et al (2009) Dual-energy and low-kVp CT in the abdomen. Am J Roentgenol 193:47–54

    Article  Google Scholar 

  22. Guimarães LS, Fletcher JG, Harmsen WS et al (2010) Appropriate patient selection at abdominal dual-energy CT using 80 kV: relationship between patient size, image noise, and image quality. Radiology 257:732–742

    Article  PubMed  Google Scholar 

  23. Arvanitakis M, Delhaye M, De Maertelaere V et al (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 126:715–723

    Article  PubMed  Google Scholar 

  24. De Cecco CN, Darnell A, Macías N et al (2013) Second-generation dual-energy computed tomography of the abdomen: radiation dose comparison with 64- and 128-row single-energy acquisition. J Comput Assist Tomogr 37:543–546

    Article  PubMed  Google Scholar 

  25. Tawfik AM, Kerl JM, Razek AA et al (2011) Image quality and radiation dose of dual-energy CT of the head and neck compared with a standard 120-kVp acquisition. AJNR Am J Neuroradiol 32:1994–1999

    Article  PubMed  CAS  Google Scholar 

  26. Schenzle JC, Sommer WH, Neumaier K et al (2010) Dual energy CT of the chest: how about the dose? Invest Radiol 45:347–353

    PubMed  Google Scholar 

  27. Kidoh M, Nakaura T, Nakamura S et al (2013) Low-dose abdominal CT: comparison of low tube voltage with moderate-level iterative reconstruction and standard tube voltage, low tube current with high-level iterative reconstruction. Clin Radiol 68:1008–1015

    Article  PubMed  CAS  Google Scholar 

  28. Yamamura S, Oda S, Utsunomiya D et al (2013) Dynamic computed tomography of locally advanced pancreatic cancer: effect of low tube voltage and a hybrid iterative reconstruction algorithm on image quality. J Comput Assist Tomogr 37:790–796

    Article  PubMed  Google Scholar 

  29. Mujica VR, Barkin JS, Go VL (2000) Acute pancreatitis secondary to pancreatic carcinoma. Study Group Participants. Pancreas 21:329–332

    Article  PubMed  CAS  Google Scholar 

  30. Mileto A, Mazziotti S, Gaeta M et al (2012) Pancreatic dual-source dual-energy CT: is it time to discard unenhanced imaging? Clin Radiol 67:334–339

    Article  PubMed  Google Scholar 

  31. Kaufmann S, Sauter A, Spira D et al (2013) Tin-filter enhanced dual-energy-CT: image quality and accuracy of CT numbers in virtual noncontrast imaging. Acad Radiol 20:596–603

    Article  PubMed  Google Scholar 

  32. Morgan DE (2014) Dual-energy CT of the abdomen. Abdom Imaging 39:108–134

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Julian Puhl and Matthias Noll from Fraunhofer IGD for their assistance with software development for this study.

The scientific guarantor of this publication is Julian L. Wichmann. The authors of this manuscript declare relationships with the following companies: Dr. Ralf W. Bauer and Dr. J. Matthias Kerl are on the speakers’ bureau of Siemens Healthcare, Computed Tomography division. However, all data was controlled by the authors (e.g. the corresponding author) without any potential conflict of interest. All other authors have nothing to disclose. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Julian L. Wichmann, Pawel Majenka, Martin Beeres, Wolfgang Kromen, Boris Schulz, Ralf W. Bauer, J. Matthias Kerl, Tatjana Gruber-Rouh, Renate Hammerstingl, Thomas J. Vogl & Thomas Lehnert

  2. Fraunhofer IGD, Cognitive Computing & Medical Imaging, Fraunhoferstr. 5, 64283, Darmstadt, Germany

    Stefan Wesarg

  3. Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Julian L. Wichmann

Authors
  1. Julian L. Wichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pawel Majenka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Beeres
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Kromen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Boris Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefan Wesarg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ralf W. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Matthias Kerl
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tatjana Gruber-Rouh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Renate Hammerstingl
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas J. Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Thomas Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian L. Wichmann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wichmann, J.L., Majenka, P., Beeres, M. et al. Single-portal-phase low-tube-voltage dual-energy CT for short-term follow-up of acute pancreatitis: evaluation of CT severity index, interobserver agreement and radiation dose. Eur Radiol 24, 2927–2935 (2014). https://doi.org/10.1007/s00330-014-3300-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3300-0

Keywords

Search

Navigation